Provider Demographics
NPI:1689898264
Name:VALENTE, SANDRA IRENE (PHD,LADC, LPC, CCS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IRENE
Last Name:VALENTE
Suffix:
Gender:F
Credentials:PHD,LADC, LPC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTRY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3191
Mailing Address - Country:US
Mailing Address - Phone:203-232-0515
Mailing Address - Fax:
Practice Address - Street 1:51 SHERMAN HILL RD
Practice Address - Street 2:SUITE A-202
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3648
Practice Address - Country:US
Practice Address - Phone:203-586-1488
Practice Address - Fax:203-586-1488
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000722101YA0400X
CT001627101YP2500X, 103TC1900X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000722CT01OtherANTHEM BS BS PROVIDER NUM
CT004257954OtherHUSKY PROVIDER NUMBER